Rein David B, Hicks Katherine A, Wirth Kathleen E, Billah Kaafee, Finelli Lyn, Fiore Anthony E, Hoerger Thomas J, Bell Beth P, Armstrong Gregory L
RTI International, 2951 Flowers Rd, Suite 119, Atlanta, GA 30306, USA.
Pediatrics. 2007 Jan;119(1):e12-21. doi: 10.1542/peds.2006-1573.
Economic analysis is an important component in formulating national policy. We evaluated the economic impact of hepatitis A vaccination of all US children ages 12 to 23 months as compared with no vaccination and with current implementation of the preexisting (issued in 1999), regional policy.
We developed a Markov model of hepatitis A that followed a single cohort from birth in 2005 through death or age 95 years. From the societal perspective, the model compared the outcomes that resulted from routine vaccination at age 1 year to 2 scenarios: no hepatitis A vaccination and hepatitis A vaccination at levels observed in 2003 under the preexisting policy. We evaluated the economic impact of vaccination nationwide, in areas where vaccination was already recommended, and in areas where no previous recommendation existed.
Without childhood vaccination, the approximately 4 million children in the 2005 birth cohort would be expected over their lifetimes to have 199,000 hepatitis A virus infections, including 74,000 cases of acute hepatitis A and 82 deaths, resulting in 134 million dollars in hepatitis A-related medical costs and productivity losses. Compared with no vaccination, routine vaccination at age 1 year would prevent 172,000 infections, at a cost of 28,000 dollars per quality-adjusted life year saved. Compared with maintaining the levels of hepatitis A vaccination under the preexisting regional policy, routine vaccination at age 1 year would prevent an additional 112,000 infections, at a cost of 45,000 dollars per quality-adjusted life year saved.
The cost-effectiveness of nationwide hepatitis A vaccination compared with no vaccination, and the incremental cost-effectiveness of this recommendation compared with preexisting recommendations, is similar to that of other accepted public health interventions. In October 2005, the Advisory Committee on Immunization Practices recommended extending hepatitis A immunization to all US children ages 12 to 23 months.
经济分析是制定国家政策的重要组成部分。我们评估了对所有12至23个月大的美国儿童接种甲型肝炎疫苗与不接种疫苗以及与当前实施的（1999年发布的）区域政策相比的经济影响。
我们建立了一个甲型肝炎的马尔可夫模型，跟踪了一个从2005年出生直至死亡或95岁的队列。从社会角度来看，该模型将1岁时常规接种疫苗产生的结果与两种情况进行了比较：不接种甲型肝炎疫苗以及按照先前政策在2003年观察到的接种水平进行甲型肝炎疫苗接种。我们评估了在全国范围内、在已建议接种疫苗的地区以及在以前未建议接种疫苗的地区接种疫苗的经济影响。
如果不进行儿童期疫苗接种，预计2005年出生队列中的约400万儿童在其一生中将发生19.9万例甲型肝炎病毒感染，包括7.4万例急性甲型肝炎病例和82例死亡，导致与甲型肝炎相关的医疗费用和生产力损失达1.34亿美元。与不接种疫苗相比，1岁时常规接种疫苗可预防17.2万例感染，每挽救一个质量调整生命年的成本为2.8万美元。与维持先前区域政策下的甲型肝炎疫苗接种水平相比，1岁时常规接种疫苗可额外预防11.2万例感染，每挽救一个质量调整生命年的成本为4.5万美元。
与不接种疫苗相比，全国范围内接种甲型肝炎疫苗的成本效益，以及与先前建议相比该建议的增量成本效益，与其他公认的公共卫生干预措施相似。2005年10月，免疫实践咨询委员会建议将甲型肝炎免疫接种扩大到所有12至23个月大的美国儿童。
